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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To assess the diagnostic usefulness of temporal artery biopsy in temporal arteritis (TA) and establish clinical features capable of predicting its positivity we have retrospectively studied the biopsy specimens and the clinical features of 103 patients who had undergone temporal artery biopsy. Temporal artery biopsy reached a positive predictive value of 90.2% with respect to the final diagnosis based on the criteria proposed by Ellis and Ralston and the clinical course. The simultaneous presence of recent onset headache, jaw claudication, and abnormalities of the temporal arteries on physical examination had a specificity of 94.8% with respect to the histological diagnosis and of 100% with respect to final diagnosis. The presence of any of these clinical features, though of little specificity (34.4%), had a sensitivity of 100% with respect to histological diagnosis, selecting a group of patients in whom temporal artery biopsy has more discriminative value.
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PMID:Clinical usefulness of temporal artery biopsy. 359 83

Forty-five consecutive patients (32 women and 13 men) underwent biopsy of the temporal artery because of suspected giant cell arteritis. Their ages ranged from 38 to 84 years, mean 68.1 years. Five patients (11.1%) four of them women, were found to be affected by the disease. Their ages ranged from 54 to 80 years, mean 69 years. Clinical and laboratory findings included elevated erythrocyte sedimentation rate, prolonged fever, continuous headache, sudden onset of unilateral blindness, intermittent mandibular claudication, severe anemia and myalgia. None of these, whether present in isolation or in various combinations, were of significant diagnostic value. All biopsies were examined both by light microscopy and by scanning electron microscopy. The former examination took about 5-7 days to complete, and the latter about 3 hours. Light microscopy studies showed that 46.6% of the arterial biopsies were normal, 42.3% were arteriosclerotic and 11.1% (5 specimens) were characteristic of giant cell arteritis. Scanning electron microscopy revealed that the biopsies obtained from all five patients found to have temporal arteritis displayed the "occlusive" pattern: the three-laminar appearance of the artery was markedly distorted or lost, the internal elastic lamina was barely detectable, and the densely hypertrophied media and intima filled the arterial lumen, virtually obliterating it. We conclude that scanning electron microscopy is a quick and accurate procedure for diagnosis of temporal arteritis and that positive findings may be taken as an indication for immediate steroid treatment.
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PMID:Scanning electron microscopy as a diagnostic procedure in giant cell arteritis. 366 83

Giant-cell or temporal arteritis is a generalized vasculitis that predominantly affects large- and medium-sized arteries in people over 50 years of age. The illness is commonly characterized by the initial symptoms of headache, temporal artery tenderness or pulselessness, musculoskeletal pain, fever, and fatigue. The most dreaded consequence of giant-cell arteritis is visual loss, which is usually irreversible on presentation. Giant-cell arteritis may present with unusual clinical manifestations such as lip, scalp, and tongue necrosis, carpal tunnel syndrome, claudication of the limbs, strokes, angina pectoris, myocardial infarction, hematuria, cough, or other CNS symptoms. The etiology of the disease is unknown. Emergency physicians are usually familiar with the more common clinical symptoms but one must consider the unusual manifestations of the disease, because early recognition and initiation of therapy (steroids) decrease morbidity and can prevent blindness.
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PMID:Giant-cell arteritis. 379 80

A 68 year-old woman presented with a two-week history of amaurosis fugax, ipsilateral fronto-temporal headache and jaw claudication suggesting carotid giant cell arteritis. However, this syndrome proved to be due to atherosclerosis causing complete occlusion of the external carotid artery at its origin and narrowing of the internal carotid artery. Combined external and internal carotid endarterectomy relieved the symptoms. The symptom complex of temporal arteritis may be rarely mimicked by carotid atherosclerotic occlusive disease.
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PMID:Temporal arteritis-like presentation of carotid atherosclerosis. 396 42

Polymyalgia rheumatica is a relatively common syndrome of older patients, mostly white, manifested by aching and morning stiffness of the pelvic and shoulder girdles and accompanied by a rapid erythrocyte sedimentation rate. The symptoms are due to a synovitis, which is mild, nondestructive and very responsive to low-dose steroid treatment, which may need to be continued for several years. Temporal arteritis, which may accompany polymyalgia, can present as headache, loss of vision, diplopia or jaw claudication. To suppress arterial inflammation and preserve vision, administration of prednisone, 50 mg a day for one month, is recommended, following which the dose is tapered according to the symptoms, not the sedimentation rate.
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PMID:Polymyalgia rheumatica and giant cell arteritis. 647 43

Thirty-five cases of cranial arteritis in an Australian population have been analysed. The female to male ratio was 2.2:1 and the average age of onset was 71 years. Eighty-five percent of patients suffered headache and this was most frequently temporal or bitemporal. Polymyalgia rheumatica (40%), permanent visual loss (29%) and jaw claudication (26%) were common, six patients complained of diplopia and four gave a past history of thyroid disease. The temporal artery was clinically abnormal in only 69% of cases but biopsy was positive in 26 of 28 specimens examined. Sixty-seven percent of patients had ESR's greater than 60 mm/h. The average duration of prednisone therapy was 22 months. Side effects of steroids were observed in seven of 19 patients followed up. The importance of starting steroid therapy as soon as the condition is suspected clinically is emphasised by the case of one patient who lost vision while awaiting temporal artery biopsy.
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PMID:Cranial arteritis. A twenty-year review of cases. 659 7

Patients with signs and symptoms of giant cell arteritis may have normal temporal artery biopsy specimens. To study the relationships between signs and symptoms of this disease and the ultimate clinical diagnosis, we reviewed 51 patients who had undergone temporal artery biopsy. The mean age of the patients with abnormal biopsy specimens was higher than that of patients with normal biopsy specimens. We found headache, fever, and jaw claudication were useful symptoms in predicting abnormal biopsy specimens. The ultimate diagnoses of patients with normal biopsy specimens and no response to treatment showed high incidence of malignant neoplasms and diabetes mellitus.
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PMID:The ultimate diagnoses of patients undergoing temporal artery biopsies. 673 72

Jaw claudication accompanies relatively few disorders, but it may be an important presenting feature that heralds serious underlying disease. In temporal arteritis, for example, jaw claudication rather than the classic finding of unilateral lancinating headache may be the distinguishing symptom. In the case reported here, jaw claudication was a prominent symptom for five months in a black woman. Temporomandibular joint disease can produce pain similar to that of jaw claudication, as can rheumatoid arthritis involving the temporomandibular joint in the elderly. Myasthenia gravis closely mimics jaw claudication, and parotid tumors can produce similar pain. Atherosclerotic narrowing of the external carotid artery proximal to the origins of the facial and maxillary branches is a rare cause of jaw claudication. Recognition of the importance of jaw claudication can lead to early identification of the underlying disease and quick initiation of therapy to avoid serious complications.
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PMID:Jaw claudication. Its value as a diagnostic clue. 682 55

Giant cell arteritis is a disease of the elderly which is more common than previously recognized. It is important to be aware of this condition because treatment effectively relieves symptoms and prevents serious complications. The disease is suggested when an elderly patient complains of constitutional symptoms, headache, jaw claudication, or the musculoskeletal manifestations of polymyalgia rheumatica. Abnormalities in temporal arteries or other cranial arteries, or evidence of large vessel involvement may be detected by physical examination. A markedly elevated sedimentation rate in association with other clinical features of the disease strongly suggests giant cell arteritis, but a biopsy should be performed to confirm the diagnosis. Corticosteroid therapy should be started promptly in high doses in order to prevent blindness. Prolonged treatment with lower dose corticosteroids is generally necessary for up to 1 to 2 years, and sometimes longer, for continued symptomatic relief. Long-term follow-up of treated patients has demonstrated no detectable effect on survivorship.
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PMID:Giant cell (cranial) arteritis: a clinical review. 699 50

Giant-cell arteritis is a polysymptomatic disease of the elderly. Systemic symptomatology includes headaches, arthralgias, myalgias, tender temporal arteries, jaw claudication, low-grade fever, anemia, anorexia, malaise, and weight loss. Visual loss from anterior ischemic optic neuropathy and diplopia resulting from ischemia of the ocular muscles represents the major ocular manifestations of giant cell arteritis. When the diagnosis is suspected, blood for a sedimentation rate should be drawn, and, if it confirms the clinical impression, high dose prednisone should be started immediately and a temporal artery biopsy performed at a later date. Only by asking the proper questions and suspecting the diagnosis will this preventable form of blindness receive the prompt attention it deserves.
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PMID:Giant-cell arteritis. Signs and symptoms. 715 21


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